[Editor’s note: This story originally was published by Real Clear Health.]
By Erika Emerson
Real Clear Health
If you’re sitting in a congressional office or any public space, look around and count the people around you. As you get to the eighth person, consider that one in eight adults in America has diabetes. Another 90 million have pre-diabetes. With such a staggering impact on America, Congress needs to take action to address the cost of prescription drugs, insufficient access to innovative medicines and devices and holes in coverage that could stop diabetes from developing or slow its impact.
Diabetes impacts more than just the 127 million Americans with diabetes and pre-diabetes, it also impacts our entire health system. Addressing the needs of people with diabetes will require more than simply applying legislative Band-aids. It will take Congress addressing problems both immediate and systemic. Since diabetes doesn’t care about your politics, members of both parties should stop talking and start acting.
Here are three crucial issues facing Americans with or at risk for diabetes, and the substantive policy solutions that Congress should enact this year:
Problem One – Rising Drug Costs
In the immediate term, Congress can enact a federal copay cap and eliminate deductibles for insulin in all health plans. This will ease the financial toxicity experienced by their constituents stuck paying inflated prices for this life saving medicine. Then it can address systemic issues driving up drug prices, like the outsized role of pharmacy benefit managers (PBMs). For more than a decade, PBMs have had the opportunity to pad their bottom line through a lack of transparency. Proposed bills, like Senator Grassley and Senator Cantwell’s Pharmacy Benefit Manager Transparency Act of 2022, seek to address the PBM issue by ensuring transparency and accountability for PBMs.
Problem Two – Diabetes Prevention
Congress must address risk factors associated with diabetes like obesity. Weight can play a crucial role in the development of type 2 diabetes. For example, 90% of American adults diagnosed with diabetes are overweight or obese. While obesity treatment can assist with prevention, many patients don’t receive treatment because of stigma, weight bias and access inequities. If passed, the Treat and Reduce Obesity Act of 2021, H.R. 1577, would address two key problems that stand in the way of receiving treatment. First, it would ensure coverage under Medicare Part D for FDA approved medications for chronic weight management. Second, it would offer more coverage for treatment with nutritionists, clinical psychologists and dietitians. Passage of this bill would improve access to care in underserved communities and help to address health disparities in populations disproportionately impacted by obesity and diabetes.
Problem Three – Affordable Medicines
Congress should improve coverage of generics and biosimilars with H.R. 2846, the Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021. One counterintuitive quirk of our insurance system is a failure to cover generics and biosimilars, lower cost medications approved as safe and effective equivalents to branded products. Biosimilar medicines typically come onto the market priced 30% below its branded reference drug. Covering these medicines would create cost savings for patients and payers alike. H.R. 2846 would address this issue by automatically covering low-cost generics and biosimilars and ensuring those medications are added to Medicare formularies immediately after they are launched.
Americans are frustrated with Washington’s gridlock. Year in and out, politicians promise to make a difference in the lives of people living with diabetes. Yet, nothing is done at the federal level. That’s why the Diabetes Leadership Council in partnership with the Diabetes Patient Advocacy Coalition is ramping up our advocacy efforts. We need you to listen to your constituents and take action on the solutions that could make a difference.
It’s time for less talk and more action on diabetes.
Erika B. Emerson is Chief Policy Officer of the Diabetes Leadership Council. She has more than 20 years of health policy and advocacy experience and holds a Master’s Degree in Public Policy from the Harvard Kennedy School and a Bachelor’s Degree in Journalism and Political Science from the University of Wisconsin-Madison
[Editor’s note: This story originally was published by Real Clear Health.]
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